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Social care: a mission to revolutionise

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Hampshire’s recommendations could defuse the ticking time bomb set to explode in social care.

When the government launched its six-month national debate on the future of funding adult social care, it called on councils to do their bit to spark grass-root discussion.

By the time the consultation closed last week, few local authorities could claim to have equalled Hampshire CC’s contribution to the pre-green paper debate.

At a time when care rationing and postcode lotteries are facts of life, few people believe that the current system is capable of dealing with the demographic time bomb that is expected to hit adult social care over the next two decades.

By the government’s calculations, 25% of the population will be 65 or over and the number of people aged 85 and above will have doubled all of which is expected to result in a£6bn funding black hole for care services, from home help to around-the-clock care.

Added to the mix are increasing disparities between the services available to those who fund their own care and those who do not, and changing expectations of what constitutes care.

Against this backdrop and the rapid rollout of personal budgets Hampshire launched its own commission of inquiry to both shape its future care services and contribute to the national debate.

With a budget of£100,000 and a panel of national and local experts including Association of Directors of Adult Social Services president John Dixon and Counsel & Care chief executive Stephen Burke the 11-member commission last week unveiled its full report with 136 pages of recommendations.

What it has come up with is a comprehensive framework that aims to guarantee minimum services to residents, regardless of their means, and offer a transparency that is currently lacking in terms of entitlement and funding.

One lynchpin of Hampshire’s scheme is preventative care with an offer of free services for up to eight weeks for anyone at risk of being admitted to hospital or about to be discharged.

The report also contains a commitment to explore ever-closer working between councils and primary care trusts (PCTs).

The aim of this move is to explore areas where budgets can be spent trying to stop people needing emergency care, rather than on treating avoidable injuries.

The commission’s findings were based on expert and grass-roots evidence gathered at four huge public hearings, each focused on separate aspects of care.

It also received more than 150 written submissions from carers and service users.

According to Ken Thornber (Con), Hampshire CC leader and commission chair, the move was a logical step for a county with a high proportion of older residents and a track record of taking bold steps with social care, such as investing in extra nursing facilities to save millions of pounds in NHS bed-blocking fees.

“We in Hampshire wanted to learn from our own commission. And if we’re in a position to help the government with its debate on personalisation of care, we’re very happy to do so,” he says. “And what we have learnt must inform the national picture.”

Cllr Thornber accepts that some of its proposals cannot be unilaterally implemented in the county alone. But he is confident those that can such as the universal offer of support and advice and the provision of eight weeks ‘urgent’ social care for those at risk of being admitted to hospital or waiting to be discharged can be delivered.

The report expects the national cost of all its recommendations to add up to an annual bill of up to£1.9bn up to one-third of which would be the expense of raising the savings threshold for means-tested care to£50,000.

But it stops short of suggesting a new funding system, such as a new kind of national insurance for care. It calls instead for a shift from “charging”.

It suggests instead a new system of individual contributions towards care needs, as assessed by the proposed standardised Resource Allocation System.

Contribution levels would then be determined according to criteria set by councils using a means test.

Cllr Thornber says he hopes a sub-group of the commission will be able to continue working on a more comprehensive funding system.

Counsel & Care’s Mr Burke argues funding was one area in which it was clear local authorities could not go it alone.

“There’s only so much that an authority like Hampshire can do and the rest needs to be done at a national level,” he says. “And experience from other countries who have had success in devising new social care systems shows that you need universal entitlements, a single funding system and support for carers. And this is what we’re hoping for in next year’s green paper.”

Possibly the most significant aspect of reforming the nation’s social care structure will be redefining the overlapping roles of council-funded social care and that provided by the NHS.

Commission member Professor Jonathan Montgomery, who chairs Hampshire PCT , says the commission received evidence suggesting some people may be continuing with local authority-funded services when they were entitled to receive a higher level of free NHS care.

“We were hearing from a number of people that they would perhaps meet the eligibility criteria for NHS Continuing Care, but that it was more important to them to have control over the budget they were spending rather than have non-means tested care provided to them by the NHS,” he says.

“It seems bizarre to me that we offer to give people more and more stability in terms of the care they are receiving, but they are concerned about losing the ability to manage their care.”

Prof Montgomery says PCTs ought to be able to come up with ways to ensure that people could get services they both needed and were entitled to without feeling they would be surrendering a valuable freedom.

Whatever models emerge from the Department of Health’s green paper on the future, plans to implement the recommendations of the commission locally in Hampshire are set to go before a full meeting of the county council later this month.

David Rogers (Lib Dem) who chairs the Local Government Association’s community wellbeing board, says while other local authorities had carried out similar work to Hampshire’s commission, no one had done it on such a scale.

He also lauds the cross-party and cross-authority ethos of the work, and called for it to continue on a national scale through the upcoming green paper discussions.

Cllr Thornber agrees such goals are crucial for coming up with the right system. He believes that ultimate proposals on the future of funding adult social care could prove too much of a hot potato to be left to “the political hurly-burly”.

He envisages the creation of an all-party thinktank ideally headed by respected grandees Frank Field, Iain Duncan Smith, and Vince Cable as the best way to properly lead the next stage of the national debate and keep political in-fighting out of the redesign of the care system.

Getting Personal: A Fair Deal for Better Care and Support.

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